[Tumours of the heart: diagnostic dilemma].

INTRODUCTION: Mitral annular calcification is a degenerative process of the fibrosus support structure of the mitral apparatus, usually spreading over the posterior mitral leaflet. CASE OUTLINE: A 66-year-old woman with shortness of breath and palpitations was referred to our institution. Echocardiography showed a round, echo-dense mass, resembling a tumour, in the posterior mitral annulus, with the third degree mitral regurgitation. Based on the findings, surgical treatment was suggested involving removal of the tumour and correction of mitral valve insufficiency. During surgery the posterior annulus was incised, whitish caseous material was aspirated and the developed cavity was closed. A bioprosthetic valve was placed in the mitral position.The aspirated material was sent to bacteriological and histological analysis. Eight days after surgery control echocardiography and CT scan of the heart showed absence of the mass. Pathohistological finding was nonspecific. Bacteriology showed Staphylococus spp. Thirteen days after surgery the patient was discharged in stabile condition. CONCLUSION: Mitral annular calcification is a common degenerative disorder particularly in elderly persons. As the diagnosis very often remains unrecognised imitating a tumor formation, precise diagnostics is necessary before possible surgery.

The fate of the radial artery conduit in coronary artery bypass grafting surgery.

Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Impressive long-term disease-free patency rate of the left internal thoracic artery-left anterior descending coronary artery (LITA-LAD) graft, coupled with proven long-term survival benefits, has led to its becoming a 'golden standard' of CABG. Previous long-term studies have also shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularization, compared with internal thoracic artery grafts. Thus, the use of arterial conduits has expanded beyond the internal thoracic arteries (ITAs) to include the right gastroepiploic artery, the inferior epigastric artery, and the radial artery. The assumption is that although the performance of one or two arterial ITA graft is superb, more arterial grafts should perform better in the long-term follow-up. Several studies concerning the use of the radial artery bypass grafts have documented excellent clinical results and satisfactory short-term as well as mid-term patency rates at restudy angiography, supporting its continued use as a bypass conduit. However, a note of caution concerning radial artery conduit patency rate have appeared in few recent reports. Thus, in this paper, we summarize the current evidence about the radial artery as a conduit in CABG surgery, with special emphasis on the clinical results.

Severity of angina as a predictor of quality of life changes six months after coronary artery bypass surgery.

BACKGROUND: Although the fact that chest pain has a negative influence on the quality of life is well known, it is not completely clear whether the preoperative severity of angina can be a predictor of the quality of life change after coronary artery bypass grafting (CABG). METHODS: We studied 243 consecutive patients who underwent elective CABG. The Nottingham Health Profile Questionnaire part 1 was used as the model for determination of quality of life. We distributed the questionnaire to all patients before and six months after coronary artery bypass surgery. Two hundred and twenty-six patients filled in the postoperative questionnaire. Severity of angina was estimated by Canadian Cardiovascular Society (CCS) classification of angina. RESULTS: Quality of life (before and after CABG surgery) in all sections was significantly worse in patients with higher CCS angina class (p < 0.001). The CCS angina class was 1.89 +/- 0.97 at baseline and improved to 0.46 +/- 0.75 (p < 0.001) after CABG. Six months after the operation, quality of life significantly improved in patients with all classes of angina (p < 0.01). The improvement in quality of life was related to higher CCS angina class in sections of physical mobility (r = 0.4, p < 0.001), energy (r = 0.31, p < 0.001), and pain (r = 0.48, p < 0.001). High CCS angina class before CABG was an independent predictor of quality of life improvement after coronary artery bypass surgery in sections of physical mobility (p = 0.005; odds ratio [OR] = 2.11; confidence interval [CI] 1.25 to 3.55), energy (p = 0.021; OR = 1.77; CI 1.09 to 2.87), and pain (p < 0.001; OR = 3.99; CI 2.2 to 7.22). CONCLUSIONS: Patients with higher CCS angina class had worse preoperative and postoperative quality of life. Patients with preoperative higher CCS angina class had greater improvement in sections of physical mobility, energy, and pain. High CCS angina class before CABG was the independent predictor of quality of life improvement six months after CABG.